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Background: The continuation of long-term warfarin therapy is gaining acceptance in minor surgeries but maintaining therapeutic international normalized ratio (INR) values among patients during major orthopedic procedures raises concern. While bridging therapy with low-molecular-weight heparin is currently recommended for patients receiving anticoagulation, few studies have evaluated the safety of continuing warfarin during total joint arthroplasty. This study evaluated the safety and efficacy of continuous warfarin anticoagulation through total joint arthroplasty with and without prophylactic tranexamic acid (TXA). Materials and Methods: We conducted a retrospective, matched-pair analysis of two experimental groups of patients who underwent primary total hip arthroplasty or total knee arthroplasty performed by a single surgeon. Our first experimental group, warfarin plus TXA (warfarin+TXA), consisted of 21 patients who underwent arthroplasty while receiving therapeutic anticoagulation with warfarin (INR, 2.0–3.0) and who received prophylactic TXA. Our second experimental group, warfarin without TXA (warfarin-TXA), consisted of 40 patients who underwent arthroplasty while receiving therapeutic anticoagulation with warfarin (INR, 2.0–3.0) without prophylactic TXA. Results: The percent change in hemoglobin value after surgery, red blood cells transfused, surgical site infections, bleeding complications, and thrombotic complications were similar between both experimental and control groups. When comparing the historical group with the warfarin+TXA group, the addition of TXA resulted in a statistical decrease in mean red blood cells transfused and estimated blood loss, with no statistically significant increase in complications. Conclusion: Many factors must be considered when choosing perioperative thromboembolic prophylaxis for arthroplasty candidates with medical comorbidities requiring long-term anticoagulation. This study presents data indicating that it could be safe and effective to continue therapeutic warfarin while using prophylactic TXA. [Orthopedics. 2024;47(4):211–216.] [ABSTRACT FROM AUTHOR]

Forest ecosystems play an important role in hydrological processes as surface and subsurface runoff, as well as the storage of water at the catchment scale. Therefore, it is important to have a greater understanding of the effects of forests in the long-term water balance of Mediterranean catchments. In this sense, this study evaluates the effect of native forests, forest plantations, and the combination of both, on long-term streamflow variations in central Chile, an unusual area of Mediterranean climate characterized by a well-marked annual cycle with dry summers and wet winters. Thus, the temporal pattern of monthly streamflow was evaluated for mean flow (Qmean), maximum flow (Qmax), and minimum flow (Qmin) in 42 large-scale (>200 km2) Mediterranean catchments. Each series of monthly streamflow data was QA/QC, and then evaluated using the Mann–Kendall's non-parametric statistical test to detect temporal variations between 1994 and 2015. In addition to the previous analysis, the monthly series were grouped into wet seasons (April–September) and dry seasons (October–April), to determine if there were any significant differences within the annual hydrological cycle. The areas covered with native and forest plantations and their relative changes were evaluated for each catchment through streamflow variations and forest cover indicators. Results revealed that streamflow variations are positive and significant when more forest cover exists. The intra-catchment relationships assessed for both species revealed the significant role of native forests and mixed masses as key ecosystems for the long-term conservation of summer streamflow in Mediterranean catchments of central Chile. These findings encourage an urgent need to create highland afforestation programs on degraded areas of central Chile, to maximize water storage in a region that is quickly drying out due to unsustainable water and land use management practices and the effects of global warming. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 52-year-old male with Dorr A femoral morphology diagnosed with bilateral avascular necrosis and osteoarthritis. The patient underwent hip replacement surgery using the Corail stem and highlights that in some cases, the Corail stem may fail due to lack of proximal fixation and distal fixation achieved at the expense of metaphyseal fixation.

The paired watershed experimental (PWE) approach has long been used as an effective means to assess the impacts of forest change on hydrology in small watersheds (<100 km2). Yet, the effects of climate variability on streamflow are not often assessed in PWE design. In this study, two sets of paired watersheds, (1) Camp and Greata Creeks and (2) 240 and 241 Creeks located in the Southern Interior of British Columbia, Canada, were selected to explore relative roles of forest disturbance and climate variability on streamflow components (i.e., baseflow and surface runoff) at different time scales. Our analyses showed that forest disturbance is positively related to annual streamflow components. However, this relationship is statistically insignificant since forest disturbance can either increase or decrease seasonal streamflow components, which eventually limited the positive effect on streamflow at the annual scale. Interestingly, we found that forest disturbance consistently decreased summer streamflow components in the two PWEs as forest disturbance can augment earlier and quicker snow‐melt processes and hence reduce soil moisture to maintain summer streamflow components. More importantly, this study revealed that climate variability played a more significant role than forest disturbance in both annual and seasonal streamflow components, for instance, climate variability can account for as much as 90% of summer streamflow components variation in Camp, suggesting the role of climate variability on streamflow should be highlighted in the traditional PWE approach to truly advance our understanding of the interactions of forest change, climate variability and water for sustainable water resource management. [ABSTRACT FROM AUTHOR]

Background Timor-Leste suffered a destructive withdrawal by the Indonesian military in 1999, leaving only 20 Timorese-based doctors and no practising specialists for a population of 700 000 that has now grown to 1.2 million. Methods This article assesses the outcomes and impact of Royal Australasian College of Surgeons ( RACS) specialist medical support from 2001 to 2015. Three programmes were designed collaboratively with the Timor-Leste Ministry of Health and Australian Aid. The RACS team began to provide 24/7 resident surgical and anaesthesia services in the capital, Dili, from July 2001. The arrival of the Chinese and Cuban Medical Teams provided a medical workforce, and the Cubans initiated undergraduate medical training for about 1000 nationals both in Cuba and in Timor-Leste, whilst RACS focused on specialist medical training. Results Australian Aid provided AUD$20 million through three continuous programmes over 15 years. In the first 10 years over 10 000 operations were performed. Initially only 10% of operations were done by trainees but this reached 77% by 2010. Twenty-one nurse anaesthetists were trained in-country, sufficient to cover the needs of each hospital. Seven Timorese doctors gained specialist qualifications (five surgery, one ophthalmology and one anaesthesia) from regional medical schools in Papua New Guinea, Fiji, Indonesia and Malaysia. They introduced local specialist and family medicine diploma programmes for the Cuban graduates. Conclusions Timor-Leste has developed increasing levels of surgical and anaesthetic self-sufficiency through multi-level collaboration between the Ministry of Health, Universidade Nacional de Timor Lorosa'e, and sustained, consistent support from external donors including Australian Aid, Cuba and RACS. [ABSTRACT FROM AUTHOR]

Abstract: This randomized trial evaluated the effect of zoledronic acid on femoral bone mineral density (BMD) following primary total hip arthroplasty. Bone mineral density was compared for up to 2years in 27 patients receiving 5mg zoledronic acid intravenous infusion and in 24 patients receiving placebo at 2weeks and 1year after surgery. Zoledronic acid prevented loss of bone mineral density at 1year (+13.8% vs +1.4%, P =.0065) and 2years (+14.3% vs −4.0%, P <.0001) in Gruen zone 1, at 1year (−8.4% vs −25.4%, P <.0001) and 2years (−9.6% vs −27.3%, P <.0001) in Gruen zone 7, at 6weeks, 6months, and 1 or 2years in Gruen zones 4 and 6. For all Gruen zones, prevention of BMD loss by ZOL was significant at 6weeks, 6months, 1year (+0.80% vs −6.03%, P <.0001) and 2years (-0.16% vs −7.13%, P <.0001). [Copyright &y& Elsevier]

Changes in vegetation cover can significantly affect streamflow. Two common methods for estimating vegetation effects on streamflow are the paired catchment method and the time trend analysis technique. In this study, the performance of these methods is evaluated using data from paired catchments in Australia, New Zealand, and South Africa. Results show that these methods generally yield consistent estimates of the vegetation effect, and most of the observed streamflow changes are attributable to vegetation change. These estimates are realistic and are supported by the vegetation history. The accuracy of the estimates, however, largely depends on the length of calibration periods or pretreatment periods. For catchments with short or no pretreatment periods, we find that statistically identified prechange periods can be used as calibration periods. Because streamflow also responds to climate variability, in assessing streamflow changes it is necessary to consider the effect of climate in addition to the effect of vegetation. Here, the climate effect on streamflow was estimated using a sensitivity-based method that calculates changes in rainfall and potential evaporation. A unifying conceptual framework, based on the assumption that climate and vegetation are the only drivers for streamflow changes, enables comparison of all three methods. It is shown that these methods provide consistent estimates of vegetation and climate effects on streamflow for the catchments considered. An advantage of the time trend analysis and sensitivity-based methods is that they are applicable to nonpaired catchments, making them potentially useful in large catchments undergoing vegetation change. [ABSTRACT FROM AUTHOR]

The longer-term effects of afforestation with Pinus radiata and Eucalyptus grandis on streamflows were analyzed using data from two paired-catchment experiments in South Africa. The experiments are rare in that they have been maintained over longer periods than the typical rotation period for industrial timber plantations in the tropics or subtropics. In both experiments the planting treatments led to large reductions in streamflow, which increased with the age of the trees and were positively related to water availability. The pine plantation caused peak reductions in yield over a 5-year period of 44 mm a−1 or 7.7% a−1 for each 10% of catchment planted when the trees were between 10 and 20 years old. The eucalypt plantation caused peak reductions over a 3-year period of 48 mm a−1 and 10% a−1 for each 10% of catchment planted. However, as the plantations matured (over 30 years of age in the case of pines and over 15 years of age in the case of eucalypts) the flow reduction trend was reversed, and streamflow effects appear to be tending toward preafforestation levels. The longer-term effects of planted forests need not be as harmful on the water yield of catchments as has been predicted from shorter-term studies. The implication of these results is that if trees are grown on very long rotations, they may be used for restoring degraded catchments or as a means of storing carbon without completely denuding available water resources. [ABSTRACT FROM AUTHOR]

Presents information on studies conducted to determine erosion and sediment yield in the western Cape province of South Africa. Details on the role of the mountains of Western Cape Province as a water supply for the region; Methods used to manage the land; Details on the burning of vegetation as a method of preserving the land.

Focuses on effects of thinning on the water yield in afforested catchments in South Africa. Reasons provided for rapidly declining streamflow at Westfalia catchment D and Cathedral Peak CII; Observation of association of thinning effects with any particular season.